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1.
Urologe A ; 59(1): 65-71, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31741004

RESUMO

Due to a safety alert issued by the US Food and Drug Administration (FDA) in 2011 for transvaginal mesh implants to treat female prolapse as a result of numerous reports of complications such as infection, chronic pain, dyspareunia, vaginal erosion, shrinkage and erosion into other organs nearly all industrial products have been withdrawn from the market in the meantime. The United Kingdom, Australia, and New Zealand extended warnings and prohibitions even on the implantation of midurethral slings (TVT, TOT). In view of these current international controversies regarding the use of implanted materials for the treatment of stress incontinence and prolapse and the lack of clear guidelines for the use of biomaterials, the opinion of the Working Group on Urological Functional Diagnostics and Female Urology should provide clarity. The Opinion is based on the SCENIHR Report of the "European Commission's Scientific Committee on Emerging and Newly Identified Health Risks", the "Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence" and in compliance with relevant EAU and national guidelines and the opinion of the Association for Urogynaecology and Plastic Pelvic Floor Reconstruction (AGUB eV). In addition, recommendations are given for the future handling of implants of slings and meshes for the treatment of stress incontinence and prolapse from a urologic viewpoint.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Slings Suburetrais/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos/instrumentação , Feminino , Alemanha , Humanos
2.
Urologe A ; 58(3): 271-283, 2019 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-30790005

RESUMO

BACKGROUND: Lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) is the fourth most common and the fifth most costly disease in men aged 50 years or older. Despite the high prevalence of LUTS/BPH in clinical practice and evidence-based guideline recommendations, there are still plenty of misconceptions on the terminology and pathophysiology of the disease, leading to false assumptions and malpractice. OBJECTIVES: Listing of commonly used false assumptions and clarification of the correct terminology and pathophysiology. MATERIALS AND METHODS: Critical reflection of 12 selected fake news based on PubMed search. RESULTS: Average prostate weight in healthy men is 20 g but varies between 8-40 g. The BPH-disease does not progress in stages; therefore, the BPH-classifications according Alken or Vahlensieck should not be used anymore. There is only a weak and inconsistent relationship between bladder outlet obstruction (BOO) and prostate size, diverticula/pseudo-diverticula, postvoid residual, urinary retention or renal insufficiency, which is too unreliable for BOO-diagnosis in the individual patient. Urethro-cystoscopy with grading of the degrees of occlusion of the prostatic urethra and bladder trabeculation is insufficient for BOO-diagnosis. There is no clinically relevant reduction of BOO with licensed BPH-drugs and no convincing data that prostate resection (TURP) has to be complete until the surgical capsule in order to obtain optimal results. CONCLUSIONS: The reasons for the persistent use of wrong terminology and pathophysiology are diverse. One reason is lack of implementation of evidence-based guidelines into clinical practice due to lack of knowledge, individual beliefs, costs, availability and reimbursement policies. Another reason is the increasing focus on oncology, coupled with underrepresented education and training on BPH.


Assuntos
Sintomas do Trato Urinário Inferior , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Obstrução do Colo da Bexiga Urinária , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/terapia
3.
Urologe A ; 56(5): 645-653, 2017 May.
Artigo em Alemão | MEDLINE | ID: mdl-27981373

RESUMO

Combined therapy of benign prostatic syndrome (BPS) with α1-blockers and 5α-reductase (5AR)-inhibitors is recommended according to two leading studies on doxazosin/finasteride and tamsulosin/dutasteride for all 10 in Germany possible combinations (five α1-blockers and two 5AR inhibitors). Because tamsulosin and finasteride predominate in the treatment of BPS in Germany, the role of the combination tamsulosin/finasteride and its scientific basis from clinical studies has been investigated. A pharmacoepidemiological extrapolation from receipts of pharmacy data centres showed a strong increase of the combination tamsulosin/finasteride since 2003. As a free combination, tamsulosin/finasteride beside the fixed combination tamsulosin/dutasteride accounts to about 50% of all α1-blocker/5AR-inhibitor combinations today. Clinical studies on tamsulosin/finasteride have been published including controlled studies of the combination and both monotherapies. The results of improvement of lower urinary tract symptoms (LUTS), maximum urinary flow rate (Qmax), prostate volume (PV) and prostate-specific antigen (PSA) as well as adverse events and drug safety are in agreement with the leading studies. However, results due to chance cannot be excluded because of deficiencies in study design. A reliable comparison of the risk of progression between tamsulosin/finasteride and both monotherapies is lacking completely. Because of the great coherence and continuous evaluation of available data of all combinations, and with the established strong class effect of monotherapies, a continuation of the therapeutic practice with the combination tamsulosin/finasteride is possible.


Assuntos
Prescrições de Medicamentos/estatística & dados numéricos , Finasterida/administração & dosagem , Sintomas do Trato Urinário Inferior/epidemiologia , Sintomas do Trato Urinário Inferior/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Hiperplasia Prostática/tratamento farmacológico , Hiperplasia Prostática/epidemiologia , Sulfonamidas/administração & dosagem , Causalidade , Comorbidade , Relação Dose-Resposta a Droga , Esquema de Medicação , Combinação de Medicamentos , Humanos , Incidência , Masculino , Tansulosina , Resultado do Tratamento
4.
Aktuelle Urol ; 47(6): 468-474, 2016 12.
Artigo em Alemão | MEDLINE | ID: mdl-27598780

RESUMO

In 2002, the International Continence Society defined the term overactive bladder (OAB) as a symptom syndrome that is accompanied by urgency with or without urge incontinence, frequency and nocturia. A proven urinary tract infection or other obvious pathologies must be excluded.The pathophysiology of OAB has not been clarified in detail and is the subject of ongoing research, so partially overlapping hypotheses exist. The urothelium-based hypothesis suggests functional changes of urothelial receptors as well as functional changes regarding the sensitivity and coupling of the suburothelial myofibroblasts, which ultimately lead to increasing activity of afferent signals and urgency. The myogenic hypothesis is based on the assumption that unstable detrusor contractions may be triggered by changes in their excitability and coupling with other myocytes or myofibroblasts. Unstable detrusor contractions generate increased afferent activity followed by symptoms of overactive bladder. The hypothesis of abnormal processing of afferent signals assumes that damage to central inhibitory pathways and/or sensitisation of afferent nerves lead to the activation of the micturition reflex, which, in turn, induces unstable detrusor contractions. In addition, hormonal and psychological influences are discussed.


Assuntos
Terminologia como Assunto , Bexiga Urinária Hiperativa/classificação , Bexiga Urinária Hiperativa/fisiopatologia , Urodinâmica/fisiologia , Vias Aferentes/fisiopatologia , Vias Eferentes/fisiopatologia , Humanos , Inibição Neural/fisiologia , Substância Cinzenta Periaquedutal/fisiopatologia , Ponte/fisiopatologia , Bexiga Urinária/inervação , Bexiga Urinária/fisiopatologia , Bexiga Urinaria Neurogênica/classificação , Bexiga Urinaria Neurogênica/diagnóstico , Bexiga Urinaria Neurogênica/fisiopatologia , Bexiga Urinária Hiperativa/diagnóstico
5.
Urologe A ; 55(2): 184-94, 2016 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-26518303

RESUMO

This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the conservative and pharmacological treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding watchful waiting, behavioral therapy, phytotherapy and pharmacological mono- and combination therapy. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail.


Assuntos
Terapia Comportamental/normas , Guias de Prática Clínica como Assunto , Hiperplasia Prostática/terapia , Obstrução do Colo da Bexiga Urinária/terapia , Conduta Expectante/normas , Inibidores de 5-alfa Redutase/uso terapêutico , Antagonistas Adrenérgicos alfa/uso terapêutico , Medicina Baseada em Evidências , Alemanha , Humanos , Masculino , Fitoterapia/normas , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico , Resultado do Tratamento , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/etiologia , Urologia/normas
6.
Urologe A ; 55(2): 195-207, 2016 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-26518304

RESUMO

This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the instrumental treatment of the lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding open and transurethral procedures (TUR-P, bipolar TUR-P, TUI-P, HE-TUMT, TUNA, and the different Laser techniques). Recommendations are also given concerning intraprostatic stents and injection therapies. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail.


Assuntos
Guias de Prática Clínica como Assunto , Prostatectomia/normas , Hiperplasia Prostática/terapia , Stents , Obstrução do Colo da Bexiga Urinária/prevenção & controle , Medicina Baseada em Evidências , Alemanha , Humanos , Masculino , Prostatectomia/métodos , Hiperplasia Prostática/complicações , Hiperplasia Prostática/diagnóstico , Resultado do Tratamento , Obstrução do Colo da Bexiga Urinária/diagnóstico , Obstrução do Colo da Bexiga Urinária/etiologia , Urologia/normas
7.
Urologe A ; 53(6): 847-53, 2014 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-24903836

RESUMO

Today, for the surgical treatment of postprostatectomy incontinence, several treatment options are available, e.g., adjustable and functional sling systems, artificial sphincter, bulking agents, and balloons. However, no recommendations in terms of specific diagnostic tools and differentiated treatment options for everyday life are available. Our aim is to provide some clinically relevant recommendations for the necessary diagnostic workup and different treatment options of postprostatetectomy incontinence to support clinical decisions in everyday life. Treatment selection should be based on contraindications. However, there is a broad overlap of the various surgical options.


Assuntos
Técnicas de Diagnóstico Urológico/normas , Guias de Prática Clínica como Assunto , Prostatectomia/efeitos adversos , Prostatectomia/normas , Slings Suburetrais/normas , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/terapia , Alemanha , Humanos , Incontinência Urinária por Estresse/etiologia
8.
Urologe A ; 52(2): 265-74; quiz 275-6, 2013 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-23354910

RESUMO

Based on the measurement of simple physiological parameters urodynamic testing can reproduce clinical symptoms in a quantitative way, associates changes in physiological parameters to pathophysiological conditions and helps to establish a diagnosis in numerous lower urinary tract dysfunctions. Furthermore, urodynamic testing allows lower urinary tract dysfunctions to be classified as storage failure, voiding failure or combined storage and voiding failure. Therapeutic decision-making is based on this classification.


Assuntos
Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/fisiopatologia , Urodinâmica/fisiologia , Adulto , Criança , Feminino , Humanos , Masculino , Uretra/fisiopatologia , Bexiga Urinária/fisiopatologia , Bexiga Urinaria Neurogênica/diagnóstico , Bexiga Urinaria Neurogênica/fisiopatologia , Incontinência Urinária/diagnóstico , Incontinência Urinária/fisiopatologia
9.
Urologe A ; 50 Suppl 1: 197-200, 2011 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-21837491

RESUMO

The Academy Spring Forums held as part of the Southwest German Congress in Tübingen and the Congress of North Rhine-Westphalia in Aachen offer urologists in private practice and likewise hospital urologists a compact overview of new developments. This article summarizes the newest work on e.g. interventional therapy, uroliths, and extracorporeal shock wave lithotripsy for benign prostatic hyperplasia and urolithiasis.


Assuntos
Hiperplasia Prostática/terapia , Urolitíase/terapia , Humanos , Terapia a Laser , Litotripsia , Masculino , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/etiologia , Fatores de Risco , Ressecção Transuretral da Próstata , Urolitíase/diagnóstico , Urolitíase/etiologia
10.
Prostate Cancer Prostatic Dis ; 14(4): 302-6, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21502969

RESUMO

CombAT (Combination of Avodart and Tamsulosin) was a randomised, double-blind study in men (n=4844) aged ≥ 50 years with a clinical diagnosis of BPH. Patients were randomised to daily tamsulosin 0.4 mg, dutasteride 0.5 mg or both for 4 years. The primary endpoint was time to acute urinary retention (AUR) or BPH-related surgery. Secondary endpoints included BPH clinical progression, symptoms and maximum urinary flow rate. A post hoc analysis of data from the European subgroup was conducted. A total of 2925 men were randomised to treatment in Europe as part of CombAT (tamsulosin, n=972; dutasteride, n=970; combination, n=983). Combination therapy significantly reduced the relative risk of AUR or BPH-related surgery compared with either monotherapy at 4 years, and also significantly reduced the risk of BPH clinical progression. Combination therapy also provided significantly greater symptom improvement than either monotherapy at 4 years. Safety and tolerability of dutasteride plus tamsulosin was consistent with previous experience of this combination and with the monotherapies. These data provide further evidence to support the use of long-term combination therapy (dutasteride plus tamsulosin) in men with moderate-to-severe lower urinary tract symptoms because of BPH and prostatic enlargement. The results in the European subgroup are generally consistent with those in the overall study population.


Assuntos
Inibidores de 5-alfa Redutase/uso terapêutico , Antagonistas de Receptores Adrenérgicos alfa 1/uso terapêutico , Azasteroides/uso terapêutico , Hiperplasia Prostática/tratamento farmacológico , Sulfonamidas/uso terapêutico , Inibidores de 5-alfa Redutase/efeitos adversos , Antagonistas de Receptores Adrenérgicos alfa 1/efeitos adversos , Idoso , Azasteroides/efeitos adversos , Progressão da Doença , Quimioterapia Combinada , Dutasterida , Humanos , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/complicações , Hiperplasia Prostática/cirurgia , Índice de Gravidade de Doença , Sulfonamidas/efeitos adversos , Tansulosina , Resultado do Tratamento , Retenção Urinária/etiologia
11.
World J Urol ; 28(3): 353-7, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19997921

RESUMO

OBJECTIVES: To investigate the symptomatic and quality of life (QoL) response to treatment with tolterodine extended release (ER) in subgroups of male patients with Overactive Bladder Syndrome (OAB) and LUTS suggestive of non-obstructive benign prostatic hyperplasia (BPH) according to age, symptom severity, diabetes mellitus status, and concomitant treatment for LUTS. METHODS: Patients treated with tolterodine ER 4 mg/day for OAB symptoms, alone or added to unsuccessful alpha-blocker treatment of > or =6 weeks duration, and presumed non-obstructive BPH (Q (max) > or = 15 ml/s) were observed for 12 weeks in a non-interventional study. Patients completed the International Prostate Symptom Score (IPSS) and Overactive Bladder Questionnaire (OAB-q) at baseline and after 12 weeks. RESULTS: 52.4% of 741 patients were aged < or =65 years; 4, 64, and 32% had mild, moderate, and severe symptoms, respectively, according to IPSS; 14% had diabetes mellitus, and in 42% tolterodine was added to alpha blockers. In the various subgroups, mean IPSS total scores improved by 2.8-11.1 points, IPSS QoL scores by 1.8-2.4 points, and all OAB-q subscores by more than 14 points. Only IPSS and OAB-q baseline scores had a relevant impact on changes during treatment, benefits were greatest in patients with more severe symptoms and bother. CONCLUSIONS: In men with symptoms of OAB and LUTS suggestive of non-obstructive BPH of all IPSS severity classes, aged < or =65 years or above, with or without concomitant diabetes or alpha-blockers, symptoms and QoL improved markedly during treatment with tolterodine ER.


Assuntos
Compostos Benzidrílicos/administração & dosagem , Cresóis/administração & dosagem , Antagonistas Muscarínicos/administração & dosagem , Fenilpropanolamina/administração & dosagem , Hiperplasia Prostática/tratamento farmacológico , Prostatismo/tratamento farmacológico , Qualidade de Vida , Bexiga Urinária Hiperativa/tratamento farmacológico , Antagonistas Adrenérgicos alfa/administração & dosagem , Fatores Etários , Idoso , Relação Dose-Resposta a Droga , Esquema de Medicação , Quimioterapia Combinada , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Probabilidade , Estudos Prospectivos , Hiperplasia Prostática/diagnóstico , Prostatismo/diagnóstico , Análise de Regressão , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Tartarato de Tolterodina , Resultado do Tratamento , Bexiga Urinária Hiperativa/diagnóstico , Urodinâmica
14.
Urologe A ; 48(3): 250-6, 2009 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-19212753

RESUMO

To improve the efficacy of medical treatment of patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH), studies on combination treatment with alpha(1)-blockers and 5alpha-reductase inhibitors, alpha(1)-blockers and muscarinic receptor antagonists, and alpha(1)-blockers and 5-phosphodiesterase inhibitors are increasingly performed. The most substantial data are available on the combination of alpha(1)-blockers and 5alpha-reductase inhibitors. This combination is not suitable for symptom improvement alone but for inhibition of progression. A combination therapy of alpha(1)-blockers and muscarinic receptor antagonists cannot be recommended as routine because of the still limited, although promising, data. Only preliminary data are available for the combination of alpha(1)-blockers and 5-phosphodiesterase inhibitors, which do not show convincing advantages over other combinations.


Assuntos
Inibidores de 5-alfa Redutase , Antagonistas Adrenérgicos alfa/administração & dosagem , Antagonistas Muscarínicos/administração & dosagem , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/terapia , Doenças Urológicas/diagnóstico , Doenças Urológicas/terapia , Terapia Combinada , Humanos , Masculino , Hiperplasia Prostática/complicações , Doenças Urológicas/complicações
15.
Urologe A ; 47(2): 149-54, 2008 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-18210073

RESUMO

The new version of the German guidelines for assessing benign prostatic hyperplasia (BPH) was written in 2006 and 2007 by experts of the BPH working group on behalf of the German Association of Urology and Federation of German Urologists. The full version is expected to be published in 2008. Recommendations for assessing BPH were modified and updated and include patient history, symptom questionnaires, physical examination, urine analysis, prostate-specific antigen, uroflowmetry, ultrasound examination of the urinary bladder (including postvoid residual urine), and ultrasound examination of the upper urinary tract or creatinine measurement. Optional tests are voiding diary, pressure-flow studies, ultrasound measurement of detrusor wall thickness, urethrocystography, and urethrocystoscopy. For the first time, tests for the differential diagnosis of bladder symptoms and BPH are described. Furthermore, the latest knowledge was added on disease progression, indications for urodynamic assessment, and ultrasound measurement of detrusor wall thickness for evaluating bladder outlet obstruction. International quality standards were applied in order to increase the guidelines' value; all tests were judged using the levels of evidence and grades of recommendation of the U.S. Department of Health and Human Services classification.


Assuntos
Exame Físico/normas , Guias de Prática Clínica como Assunto , Hiperplasia Prostática/diagnóstico , Ultrassonografia/normas , Urologia/normas , Alemanha , Humanos , Masculino , Hiperplasia Prostática/classificação , Síndrome
17.
World J Urol ; 25(6): 627-33, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17906864

RESUMO

Patients with presumed non-obstructive BPH (Q (max )>or= 15 ml/s) treated with tolterodine ER 4 mg/day for OAB symptoms, alone or added to unsuccessful alpha-blocker treatment of >or=6 weeks duration, were observed for 12 weeks in a non-interventional study to generate real-life efficacy and safety data. Patients completed the IPSS, the OAB-q and a 2-day micturition diary at baseline and 12 weeks. PVR was determined sonographically. Seven hundred and forty one patients were analysed. Mean PVR did not increase (25.4 +/- 26.5 vs. 29.3 +/- 30.9 ml at baseline). AUR requiring catheterization occurred in two patients, acute UTI in four patients. Median IPSS total scores decreased from 17 to 10, IPSS QoL scores from 4 to 2, OAB-q symptom bother scores from 50.0 to 22.5 and OAB-q HRQL scores increased from 59.2 to 81.6. In men with OAB symptoms and presumed non-obstructive BPH, tolterodine ER provided considerable symptomatic and QoL improvements with a low risk of AUR, acute UTI, or increased PVR.


Assuntos
Compostos Benzidrílicos/administração & dosagem , Cresóis/administração & dosagem , Antagonistas Muscarínicos/administração & dosagem , Fenilpropanolamina/administração & dosagem , Hiperplasia Prostática/tratamento farmacológico , Bexiga Urinária Hiperativa/tratamento farmacológico , Idoso , Compostos Benzidrílicos/efeitos adversos , Cresóis/efeitos adversos , Preparações de Ação Retardada , Humanos , Masculino , Pessoa de Meia-Idade , Antagonistas Muscarínicos/efeitos adversos , Fenilpropanolamina/efeitos adversos , Hiperplasia Prostática/psicologia , Qualidade de Vida , Análise de Regressão , Índice de Gravidade de Doença , Tartarato de Tolterodina , Resultado do Tratamento , Bexiga Urinária Hiperativa/psicologia , Incontinência Urinária de Urgência/tratamento farmacológico , Incontinência Urinária de Urgência/psicologia , Urodinâmica
20.
Urologe A ; 44(5): 505-12, 2005 May.
Artigo em Alemão | MEDLINE | ID: mdl-15841355

RESUMO

5alpha-Reductase inhibitors and alpha(1)-receptor blockers are established options for symptomatic treatment of benign prostatic hyperplasia (BPH). Achieving maximum efficacy is contingent on correct dosage and requires careful patient selection in view of the substance class employed. All applicable preparations exert only a low-grade effect on prostatic obstruction. This condition should be excluded by appropriate urological examination before treatment is initiated. If the patient's distress is minor, refraining from drug therapy can be considered. Symptomatic patients with small prostate volume are suited for monotherapy with alpha(1)-receptor blockers and symptomatic patients with large prostate volume profit from combination therapy. When 5alpha-reductase inhibitors are used, BPH patients should be made aware of the findings from the Prostate Cancer Prevention Trial.


Assuntos
Inibidores de 5-alfa Redutase , Antagonistas de Receptores Adrenérgicos alfa 1 , Antagonistas Adrenérgicos alfa/administração & dosagem , Inibidores Enzimáticos/administração & dosagem , Hiperplasia Prostática/tratamento farmacológico , Medição de Risco/métodos , Ensaios Clínicos como Assunto , Relação Dose-Resposta a Droga , Combinação de Medicamentos , Humanos , Masculino , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Fatores de Risco , Resultado do Tratamento
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